{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:02:51Z","timestamp":1790179371792,"version":"4.1.0"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,9,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intrathecal baclofen (ITB) therapy effectively manages severe spasticity. While mechanical complications typically cause therapy loss or withdrawal, structural disruptions can remain completely occult due to anatomical adaptations. This report explores the unique management of an incidentally discovered catheter transection during routine reservoir exchange.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A female patient in her 30s with cerebral palsy had been treated with ITB since 2011 without functional complaint, despite sluggish cerebrospinal fluid (CSF) flow noted at a 2019 pump exchange that did not prompt catheter revision. After relocating out of state, the patient returned in 2025 for a planned pump reservoir replacement, reporting no interval decline. Preoperative catheter port myelography was not successful due to failure of CSF aspiration from the catheter access port, and intraoperative exploration revealed the catheter was completely fractured at its fascial insertion point, despite the reported years of clinical stability. Fragment retrieval required partial laminectomy and multilayer dural repair; after new hardware placement and retitration, her therapeutic outcome improved dramatically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Subjective clinical efficacy is an unreliable proxy for system patency. Aging hardware configurations require proactive radiographic monitoring and targeted surgical revision to minimize the risk of withdrawal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-108277","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:20:39Z","timestamp":1790176839000},"page":"rapm-2026-108277","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Asymptomatic intrathecal baclofen pump catheter failure discovered during routine reservoir replacement: a case report"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8941-863X","authenticated-orcid":false,"given":"Heeho","family":"Kim","sequence":"first","affiliation":[{"name":"University of Virginia Department of Anesthesiology, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8038-6762","authenticated-orcid":false,"given":"Priyanka","family":"Singla","sequence":"additional","affiliation":[{"name":"University of Virginia Department of Anesthesiology, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"2026092308202860000_rapm-2026-108277v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198906083202303"},{"key":"2026092308202860000_rapm-2026-108277v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(99)00153-0"},{"key":"2026092308202860000_rapm-2026-108277v1.3","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12467"},{"key":"2026092308202860000_rapm-2026-108277v1.4","article-title":"Catheter dysfunction in long-term intrathecal baclofen pump users and when to evaluate integrity: A case series","volume":"3","author":"Dean","year":"2024","journal-title":"Interv Pain Med"},{"key":"2026092308202860000_rapm-2026-108277v1.5","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1111\/ner.13097","article-title":"Intrathecal Baclofen for Severe Spasticity: Longitudinal Data From the Product Surveillance Registry","volume":"23","author":"Schiess","year":"2020","journal-title":"Neuromodulation: Technology at the Neural Interface"},{"key":"2026092308202860000_rapm-2026-108277v1.6","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.neurom.2024.03.003","article-title":"The Polyanalgesic Consensus Conference (PACC)\u00ae: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain","volume":"27","author":"Deer","year":"2024","journal-title":"Neuromodulation"},{"key":"2026092308202860000_rapm-2026-108277v1.7","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/ner.13153","article-title":"Catheter Access Port (Computed Tomography) Myelography in Intrathecal Drug Delivery Troubleshooting: A Case Series of 70 Procedures","volume":"23","author":"Delhaas","year":"2020","journal-title":"Neuromodulation"},{"key":"2026092308202860000_rapm-2026-108277v1.8","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1111\/ner.13412","article-title":"Low Rate of Intrathecal Baclofen Pump Catheter-Related Complications: Long-Term Study in Over 100 Adult Patients Associated With Reinforced Catheter","volume":"24","author":"Feller","year":"2021","journal-title":"Neuromodulation"},{"key":"2026092308202860000_rapm-2026-108277v1.9","doi-asserted-by":"crossref","first-page":"493","DOI":"10.3171\/2016.4.PEDS15646","article-title":"Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications","volume":"18","author":"Motta","year":"2016","journal-title":"PED"},{"key":"2026092308202860000_rapm-2026-108277v1.10","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s13244-017-0568-z","article-title":"Plain radiography in patients treated with intrathecal drug delivery using an implantable pump device","volume":"8","author":"Delhaas","year":"2017","journal-title":"Insights Imaging"},{"key":"2026092308202860000_rapm-2026-108277v1.11","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.3346\/jkms.2012.27.10.1278","article-title":"An intrathecally located broken catheter used for an intrathecal drug delivery system","volume":"27","author":"Kim","year":"2012","journal-title":"J Korean Med Sci"},{"key":"2026092308202860000_rapm-2026-108277v1.12","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1111\/ner.12799","article-title":"Removal of Intrathecal Catheters Used in Drug Delivery 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